Beyond the Prescription: The Expanding Role of Pharmacists in Athlete Care

In this Pharmacy Times Q&A, Erin Dorval, PharmD, discusses the evolving role of pharmacists in athlete care, emphasizing the importance of balancing performance optimization with medication safety. She highlights how pharmacists can support recovery, guide appropriate use of medications such as nonsteroidal anti-inflammatory drugs, and help athletes navigate supplements and over-the-counter products. Dorval also underscores the value of a holistic, patient-centered approach that considers both acute injuries and long-term health, as well as emerging opportunities in preventive care and personalized treatment strategies. Her insights reflect the growing impact of pharmacists in sports medicine and athlete performance.

Pharmacy Times: As sports pharmacy continues to grow as a specialty, what do you see as the most important role pharmacists play in supporting athletes’ overall health, performance, and recovery?

Erin Dorval, PharmD: Fantastic question—one that I think about a lot in terms of trying to integrate myself into the care. I think it's pharmacists’ abilities to optimize outcomes by minimizing risk.

A lot of the things that I do on a daily basis involve making sure that the medication is appropriate and that it's going to help with the athlete's performance, but not hinder it. So, things like medications for inflammation—you want to make sure that it's used appropriately for the right amount of time and that it doesn't hinder healing in any type of acute injury.

The other area, too, that I focus on a lot is recovery. I think athletes sometimes think, especially with an injury, “let me get the medication, let me get over it.” But a lot of it has to do with whether they are sleeping enough, whether they are getting good nutrition every day, whether they are stretching, and whether they are planning rest days—so making sure that they have a good recovery plan.

Pharmacists, I think, look at things holistically because we're focusing not just on the medication for the injury, but maybe everything else that the patient may have, including chronic conditions. So, we’re making sure that we’re documenting all the care that they have.

It can change, too, based on high school athletes, where I think I've been able to help those types of athletes a little bit more with just knowing what's out there. Making sure that they're not taking supplements that may not be recommended or using energy drinks at an inappropriate time.

Then, as you move to college or elite athletes, it's really about making sure we're managing those medications so that they can achieve top performance. But I even think of athletes as our weekend warriors. A lot of the time, I'm looking at the population that's doing marathons or maybe wants to do something like a Spartan Race—making sure that they manage their medications appropriately and treat their injuries as well appropriately.

Pharmacy Times: How can pharmacists help bridge the gap between performance optimization and medication safety, particularly when it comes to supplements, OTC products, and potential drug interactions?

Dorval: One of my favorite areas is supplements and over-the-counter medications. I think a pharmacist is kind of a 2-sided coin, where we're a filter and we're a translator.

What I mean by “filter” is that we want to make sure we remove anything that's potentially unsafe, ineffective, or maybe even contaminated—especially with supplementation. I do a lot of work with patients in the clinic to choose a supplement that not only has good manufacturing standards but is also maybe third-party tested to make sure that the ingredients in there are what they are really looking for.

Then, as a translator, we're kind of turning that really complex pharmacology knowledge into something actionable for them. A lot of times, I see patients ask, “What is this medication for? Why am I even taking it?” And really, what we're trying to do as pharmacists is counsel them on why this medication is appropriate for their care at this time and how it's working in the body.

So I'm looking at it through: Is it safe? Is it effective? With athletes in particular, too, is it allowed? Making sure that we're not giving a supplement that may be potentially banned or on the prohibited list. And then, does it fit into their overall picture?

There's a lot of stuff on social media now that says this supplement is really good for this, or this supplement is going to help in this type of performance. But is it necessary? A lot of times, I think athletes feel like they need more and more to help them get better, when they may already be on the right track—we just need to stick with their training plan. So, what's the bigger picture?

Pharmacy Times: What are some key considerations pharmacists should keep in mind when counseling athletes on pain management, especially in avoiding overuse or misuse of medications like nonsteroidal anti-inflammatory drugs (NSAIDs)?

Dorval: Pain management is a tough one because pain is not comfortable, and most of the time, patients—whether that's athletes or other patients—do not want to have pain. But we have to remember pain is just a signal; it's not a disease.

I think that's where pharmacists can come in, because a lot of the time, I've seen athletes take medications like nonsteroidal anti-inflammatory drugs before they train, before they have a game or a match, and it's there for prophylaxis—and that's not appropriate. We don't want to mask an injury potentially. So, if something did happen during the game, that NSAID that they took before the game may not actually show up until it's a much bigger issue.

The other thing is how long we are taking the medication for. We want to make sure that NSAIDs are used at a time, but they're not continued indefinitely, because a lot of the times that can also delay healing of the injury. So, we do want to make sure that it's only used for the appropriate time and that it is an effective dose.

I've seen some patients use very high NSAID dosages, and then I've also seen the other side of it, too, where they don't take as much as they should be, so they're actually not helping with pain relief—and it's a medication that's not helping at all.

Beyond that, too, is making sure the patients understand that there are topical options. There are a lot of different NSAIDs now, whether it's a compounded product or even stuff that's over the counter or prescription that you can use where we don't have to use a PO or oral product. With oral medications, you want to make sure the patient is hydrated enough to protect the kidneys and then consider alternatives.

I think sometimes pharmacists don't always have to give medications. So, can we think of rest, ice, heat, compression? Are those types of things that maybe we can do instead of an NSAID?

Pharmacy Times: For pharmacists who are interested in getting more involved in sports pharmacy, what skills or areas of knowledge do you think are most critical to develop early on?

Dorval: This is another really good question, because I am somebody who came to sports pharmacy a little bit later in her career. This was not an opportunity when I first graduated from pharmacy school. As I've come into it, I think there's not one single skill set that really helps you prepare for this job—I think it's a number of different options.

Definitely the first one is having very strong pharmacology knowledge—that clinical knowledge of thinking outside the box. How is that medication optimized? Are there different formulations that we could try? So, really making sure that their pharmacology knowledge is strong, and that their evidence-based drug information skill set is strong. A lot of the time, I'm on the fly, looking something up real quick to see what the evidence is behind doing something differently or finding a new way of treating an injury or an ailment the athlete may have.

One of the things that I did first was inform myself about the World Anti Doping Agency and make sure I knew about the prohibited list. So that's something that those who are interested can do before looking for opportunities like this.

Making sure you have strong communication skills is also key, and this goes both ways—communicating with the provider to make sure that you're giving them concise details about medication options, and then with the patient as well, being able to counsel them fully on how you're using the medication in their treatment plan. What are the different options? What are the [adverse] effects? How long are we going to do it? There are a lot of things that the patient needs to know that the pharmacist can step in and counsel them on.

I think the only other thing I would add to this question is that there are a lot of opportunities outside of formal skills. A lot of times, pharmacists think, “I need to take a certification,” or “I need to learn this textbook,” and those are all very good options—they're just limited right now in sports pharmacy.

Having the opportunity to do a community event is a great place to start. One of the things that I started with was a group of girl athletes in a high school, and just being able to talk to them about nutrition and recovery methods. That kind of leads to other questions from either community groups, and allows you to get comfortable with talking in a more siloed area.

Pharmacists sometimes are used to talking in a very holistic manner in patient care, and now you're focusing yourself much more into the world of athletes. So, starting small always helps, and then it grows your confidence—you already have a lot of the knowledge; it's just about maximizing that information in a single area.

Pharmacy Times: Looking ahead, what emerging trends or innovations in sports medicine or pharmacy practice are you most excited about, and how might they shape the future of athlete care?

Dorval: This is something I'm really excited to see—where sports pharmacy goes. Coming into this type of specialty right now, where it's continuing to evolve and emerge, is fun.

[An area] where I think pharmacists can be the most impactful is preventive care. A lot of health care now is moving from reactive to proactive, so being able to use the pharmacist in that area for preventive care kind of leads itself into more personalized recommendations.

With preventive care, you can't just tell a person, “OK, you need diet and exercise.” What type of diet for that patient? What type of exercise is appropriate for that type of athlete? So this comes down to personalized recommendations, and there's a lot of different knowledge now coming out with pharmacogenomics and nutrigenomics to be able to use that to tailor our recommendations for that specific patient.

The other area, which even lends itself more to it, is the wearable data that we're getting from some of the newer technology. I think the pharmacist can play that intermediate role, because data [are] only good if you're able to interpret [them]. Pharmacists have the ability to look at [those] data to really optimize performance with patients.

A good example is continuous glucose monitors. They're being looked at now to be used in patients who do not have diabetes. So, how are we using this to really drive peak performance in athletes? That’s an area that I'm excited to look into more.

A lot of advanced therapies are on the horizon, so pharmacists being able to be knowledgeable and able to counsel patients—and make the athlete aware of the options that they have beyond some traditional medications—is really important.